How Was Your Day?

HOW WAS YOUR DAY?

SUBMISSIONS MUST REMAIN ENTIRELY FREE OF CLIENT CONTENT TO PROTECT PRIVACY AND CONFIDENTIALITY.
Please take a few minutes before the end of your shift to fill out this questionnaire to help us improve or maintain our performance at this location. All comments are confidential. Thank you for your cooperation and input.
Your Name:
LAST NAME, FIRST NAME
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position:
Service Unit (location):
Shift:
Caregiver(s) you worked with:
Full name(s)
1. Were you greeted warmly by all staff working when you came in?
2. Were you introduced to those you may not have met yet (staff and clients)?
3. Were the staff helpful? Explained routine, shift duties, etc?
4. Were you asked throughout the shift if you required any help?
5. Did you get help/direction when/if you asked the person you were working with?
6. Did you feel included or part of the TEAM? Please give examples.
7. How would you describe overall your shift today?
8. How would you describe overall the environment of the home today? Please explain contributing factors.
Team Leader was made aware of my negative experience. Do you feel your concerns were addressed by the TL?
Follow up notes - if required
Should be Empty:

HOW WAS YOUR DAY?